EmailMe Form - ABUSE-FINANCIAL, PHYSICAL-PROTOCOLS/ Reminder EMF

Today's Date *

MM / DD / YYYY

Your Name *

Email

READ ALL PROHIBITED ACTIVITIES VERY CAREFULLY TO AVOID POTENTIALLY BREAKING THE LAW AND AVOIDING CRIMINAL PROSECUTION AND JAIL TIME

If you have any questions about any of the following or if you feel you may have mistakenly engaged in any of the following, you must tell us now to avoid prosecution under NYS and Federal penal codes. If you are aware of anyone (including another Home Instead caregiver) please bring it to our attention now at 212-614-8057

#1 - Credit or Debit Cards.

Reading the numbers (for online food delivery) is prohibited

Signing on behalf of a senior or anyone else (even at their request) is prohibited *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for identity theft, forgery or elder abuse (even if a senior or their family ask me to do this to them as a one time favor)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#2 - Checks - Signing (or writing) a check for a senior is illegal. *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for identity theft, forgery or elder abuse (even if a senior or their family ask me to do this to them as a one time favor)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#3- Cash: handling more than $50 in cash of a client's money at any given time without informing the office. *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for theft, undue influence, elder exploitation or elder abuse (especially if a senior has any form of dementia)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#4 - ATM Machines: going to an ATM machine on behalf of a client and making a deposit, taking out money, touching the money, counting the money or even knowing their PIN number *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for theft, undue influence, elder exploitation or elder abuse (especially if a senior has any form of dementia)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#5 - Gifts. Accepting a cash or gift of any nature without approval from the office. *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for theft, undue influence, elder exploitation or elder abuse (especially if a senior has any form of dementia)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#6 - Borrowing money. Asking client for money for any reason is strictly prohibited (if you need money, you can ask the office) *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for theft, undue influence, elder exploitation or elder abuse (especially if a senior has any form of dementia)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#7 - Wills/ Testament. Accepting or asking to be included in client’s last will or testament (or related succession arrangements). *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for theft, undue influence, elder exploitation or elder abuse (especially if a senior has any form of dementia)

I was not aware of this and feel I may have accidentally violated this (I will describe here or call the office asap)

#8 - Use of a client's personal property (including computers, cell phones) *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for trespass of property (even if a senior or their family allow me to do so)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#9 - Food. Ordering food with client's money or with client's credit card or account with a local merchant is considered trespass of property unless approved by the agency. *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for trespass of property (even if a senior or their family allow me to do so)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#10 - Friends. Allowing a friend or personal acquaintance during your shift or joining a friend during a shift. *

I am aware of this policy and have never violated it nor plan on violating it, understanding I may be prosecuted for neglect, abandonment and elder abuse (even if a senior says it is OK to do so)

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#11 - Neglect. Leaving your client alone for even 5 minutes during or before the end of your scheduled shift without permission from the office is considered patient care abuse and financial abuse. *

I am aware of this policy and I have never violated it nor plan on violating it, understanding I may be prosecuted for neglect, abandonment and elder abuse (even if a senior says it is OK to do so).

I was not aware of the above and feel I may have accidentally violated this (I will describe here).

#12 - Duration of the Shift. Clocking In and Out. *

I am aware of the fact that I may not ask another caregiver or the client to clock me in or out, and I may not clock in or out from any other phone than the client's home phone, since this is considered patient care and financial abuse.

I was not aware of the above and feel I may have accidentally violated this (I will describe here).

#13 - Physical abuse. Inflicting physical pain or injuring a senior (such as bruising, restraining, slapping). *

I am aware of this policy and have never violated it nor plan on violating it, understanding I will be prosecuted for elder abuse.

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#14 - Shouting, Yelling = Emotional abuse. Causing mental pain, anguish, or distress on an senior through verbal or nonverbal acts, e.g. humiliating, intimidating, or threatening. Shouting at a senior is considered elder abuse *

I am aware of this policy and have never violated it nor plan on violating it, understanding I will be prosecuted for elder abuse.

I was not aware of this and feel I may have accidentally violated this (I will describe here)

#15 - NANNY CAMS

Please note that over 65% of our clients have nanny cams, please do not do anything you will regret *

I am aware of this

I was not aware of this and now I am

Criminal Prosecution (you must check off both) *

(1) I understand Home Instead Senior Care views any of the things above as a breach of trust, as well as a potential commission of a serious crime under NYS and Federal laws and will ensure prosecution of anyone involved in any of those activities

(2) I understand there are exceptions to these rules that can only be permitted if the agency approves in writing

Each one of us has a responsibility to keep vulnerable elders safe from harm. Please report any suspicion of elder exploitation or abuse. We will investigate while keeping your name confidential.

Please let us know if you have questions or if you know of anyone who may be violating these policies (including other Home Instead employees)

NOTE!!

If you are faced with a situation where you don't know how to act and you feel you may be violating any of these policies accidentally, please call the office to discuss with us now.

All employees who are found violating these policies will be reported to the applicable entity:

1. NY Police Department,
2. FBI,
3. NYS Attorney General, &
4. Adult Protected Services.

Convictions in any of these areas can follow you for decades.

If it's not clear, please call us at 212-614-8057. We are here to protect you if and when you follow these protocols

Signature - by signing my name here I am acknowledging all agency policies and the accuracy of the information I am providing *

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Sign your name with mouse or with your finger

Any questions? Call us at 212-614-8057 or email us at *